1,723 Patients

More than 1,700 people waited in line for hours to get free dental care at a clinic in Columbia, Mo. this month. The turnout for this clinic, called the Missouri Mission of Mercy, reveals a hidden crisis: the expense of dental care and lack of access are major obstacles for many throughout the state and the country.

Throughout the event, held July 31st - August 1st, a team of reporters from the KBIA Health & Wealth Desk spoke to the patients receiving treatment at the event, and the volunteers who made it all possible.

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15:59

Thursday Afternoon - Almost Ready

Less than 24 hours before the doors opened for the Missouri Mission of Mercy, or MOMOM as it is more commonly known, Ben Hopper and Gerry Murphy were huddled over a vacuum pump that just wouldn’t work.

Gerry Murphy helped set up and and break down the equipment for the event before sending it on to its next location - Alaska.

Credit Bram Sable-Smith / KBIA

These two travel across the country to help set up equipment for Mission of Mercy events in different states. These “MOM” events are two-day dental clinics that provide fillings, cleanings and extractions free of charge to people who can’t otherwise afford it. At least 31 states hold events like these.

This year's was Missouri’s fourth event and the first held in Columbia. Because of the expected attendance - organizers anticipated as many as 2,000 patients - it was housed in a gymnasium at the Hearnes Center, a sports arena at the University of Missouri.

By mid-afternoon on Thursday, Hopper and Murphy had already been in the gym since 7:30 a.m. setting up the chairs, tables and dental stations all of those patients would use.

They were almost finished. All they had left was to get this last vacuum pump working.

When they first tried to set it up, the vacuum was blowing instead of sucking, which was a problem because this vacuum connected to the suction devices at about a quarter of the dental stations. This one pump was going to be responsible for sucking all the saliva from about 500 peoples’ mouths in the next two days, and pumping it all into a big biohazard container.

But Hopper was not concerned.

“If it gets wired wrong, it blows instead of sucks up,” he said calmly. “We just gotta switch those around and they’ll be working.”

Sure enough, they switched the wires, and tried the pump again. This time it was sucking away and, with that, the stations were ready to go.

The doors to the clinic were open 5 a.m. to 5 p.m. on Friday and again on Saturday. In that time, volunteers tried to treat as many patients as possible.

By Thursday night, people were already beginning to gather outside the arena with the plan to spend the night in line and be the first in the doors Friday morning.

Thursday Night - The Wait Ahead

By 8 p.m. a line of thirty people snaked along the edge of the Hearnes Center. They’d brought chairs and coolers and sleeping bags and were getting ready to spend the night camped out.

There was a light smell of cigarette smoke in the humid evening air, and the line was reminiscent of fans waiting to buy concert tickets or shoppers waiting for the doors to open at a Black Friday sale.

But these people from all over Missouri were going to receive an even better value for their time – free dental care that would usually cost hundreds or even thousands of dollars, depending on how much work they need done. Many of the people in line needed multiple extractions or reconstruction of broken teeth to deal with long-term painful conditions.

Seth Nevels, 23, waited in line Thursday night to be the first in the door Friday morning.

Credit Sara Shahriari / KBIA

Seth Nevels was first in line. He’s a cook at a restaurant in Sedalia, Mo., about an hour away. He’s young, just 23 years old. He believed he needed as many as eight teeth pulled, as well as some fillings. The pain in his teeth, he said, was constant.

“It ripples through your whole body, and it affects everything,” Nevels said. “Not to mention just your mental state obviously will be affected. You’re going to be more irritable, grouchy, and unable to handle stuff or concentrate with that much pain.”

Nevels doesn’t have dental insurance, so it’s unlikely he’d be able to get this care any time soon if not for the clinic.

There’s very little solid information on how many Missourians go without dental insurance. According to a Surgeon General’s Report from fifteen years ago, for every adult without health insurance, there are three without dental insurance.

Some 2.4 million Missouri adults, or roughly 53% of the adult population, could be without dental insurance.

Following that equation, the Missouri Department of Health and Senior Services estimated in 2014 that some 2.4 million Missouri adults, or roughly 53% of the adult population, could be without.

Margie Hughes, who made the 45-minute drive from Moberly, Mo. on Thursday, was the second patient in the doors Friday morning.

Credit Sara Shahriari / KBIA

Margie Hughes, who made the 45-minute drive from Moberly, Mo., was second in line, and she is one of those Missourians. In the past five years she has had two teeth pulled – each of which cost her $300. She said the state of her teeth worries her constantly.

“I need approximately six or seven teeth pulled, because they’re all broke off in my mouth,” Hughes said. “And I have puss pockets on my upper gums and stuff that I have to manually drain three or four times a day in order to keep it from swelling too bad and keep the pain down.”

Gary Bohrer is from Monroe City, a town of 2,500 people about two hours away from Columbia. He has health insurance through his job, but hasn’t had dental insurance for years. He smiled to show a line of broken and cracked teeth a dentist told him would cost $4,200 to fix.

“I used to have dental care when I lived in Florida,” Bohrer said. “I had dental care and they filled a bunch of them, but then the job went debunked and I lost the insurance. And after that I couldn’t afford it no more. And now the fillings are coming out, the teeth are breaking off, and I just can’t afford to get them pulled.”

His strategy has been to take care of the very worst and most painful teeth as they act up, and as he can pay for it.

By 9 p.m. more people arrived with family members and friends, joining the orderly line and setting up their chairs, blankets and food. The doors still wouldn’t open for another eight hours.

Friday Morning – 'You Are Our Guests'

People stood in line for hours to receive free dental care at the event.

Credit Bram Sable-Smith / KBIA

Eight hours later, at 5 a.m. the next morning, it was still dark outside. Crickets chirped in the few trees lining the parking lot. Overhead, the almost full moon glowed whiter and brighter than the street lamps.

There were already hundreds of people in line, snaked all the way from the entrance doors, across the side of the arena, then along a sidewalk and then around the edges of the parking lot.

Paul Roberts, the foundation and outreach director for the Missouri Dental Association, came outside to address the crowd.

“Good morning,” he said. “In about half an hour we’re going to open the doors. I just want to give you an idea of what to expect and how you can help us help you. Because you are our guests.”

Handling this many patients over such a short period of time requires a highly orchestrated plan.

A sign in the volunteer hospitality area at the clinic.

The first thing patients did when they got inside was rinse their mouths with mouthwash. Then it was on to registration, followed by a general health screening and then a dental screening.

After that, those who needed them got x-rays, then it was on to a waiting area where they sat until there was an open chair for their procedure. The length of this wait depended on the procedure the patient needed.

At each step along the way there were people volunteering their time and services, working as greeters, translators, escorts, hygienists, dentists and oral surgeons. There were more than a thousand volunteers over the course of the weekend, making the entire event possible.

Helping to organize all of them was Lori Henderson, a pediatric dentist from Columbia. As the event's co-chair, she worked on planning this event for more than a year.

Friday Afternoon - A Hard Place

Lori Henderson’s day began at 4 a.m. with a problem. Temperatures were predicted to be in the 90s, and the gym didn't have an air conditioner. They had rented temporary air conditioner units for the clinic, but when she arrived on Friday, she realized the generator that powered the units had broken overnight.

Lori Henderson, worked alongside other volunteers, to ensure that everything ran smoothly at this year's MOMOM event.

Credit Rebecca Smith / KBIA

So she and other volunteers thought quickly and solved the problem by moving the large industrial fans cooling people outside, inside.

Then to ensure those standing outside could stay cool, the volunteers went through and handed out handheld fans. The kind on a stick that you wave back and forth.

By 10 a.m. the day had begun to heat up. Henderson walked up and down the line of patients outside just making sure they were keeping cool and reassuring them they'd be seen today.

“The line is down quite a bit,” she said. “I hope it’s moving for the sake of all these wonderful people. Thank you all for being here.”

Temperatures outside approached 90 degrees, and to keep cool, Henderson decided to take a few laps through the misters - essentially PVC pipe doorways that spray water through tiny holes - set up outside.

"Like the kids," she said, "because it feels pretty doggone good."

Once she got back inside Henderson became the guide for a patient from Fulton, Missouri, which is the seat of a rural county about half an hour east of Columbia. Lori was ensuring the patient, a woman named Heather, got the proper treatment.

Nearly 2,000 patients received care over the course of the two-day event.

Credit Rebecca Smith / KBIA

After a few minutes and a few more x-rays, Lori introduced Heather to her dentist for the day – one of the many who volunteered at the event.

Missouri has 4,000 licensed dentists. But only 751 work in areas that are classified as rural, serving the more than 2 million Missourians who live in rural areas.

The majority of Missouri’s counties - 99 out of the 114 – are also Dental Health Professional Shortage areas. This means the federal government decided there aren’t enough oral health professionals to meet the needs of the county’s residents.

Many patients wrote notes of appreciation to the volunteers, which were then displayed for all to see.

Credit Rebecca Smith / KBIA

One state report said this leaves more than one million Missourians without routine access to dental care.

While rural areas also tend to have higher rates of low income, Henderson said that regardless of where you live, the real issue with dental care in Missouri is the ability to pay.

“If people can't afford to go it wouldn’t matter if you had 15 dentists,” she said.

Henderson said that’s where Medicaid adult dental benefits would help. Children, pregnant women and people with certain disabilities are all eligible for dental benefits under Medicaid, but it’s up to the states to decide whether to also offer benefits to adults.

The Missouri state government hasn’t funded Medicaid adult dental benefits for the better part of a decade – since 2005.

“People are caught in a hard place,” Henderson said. “We hope someday that we'll be able to have one of these clinics set up and there'll be nobody in line, or 50 people in line because then that will mean that we have done something legislatively that is a more inclusive solution.”

Last year, the state actually budgeted for Medicaid adult dental benefits, but it was among the funds the Governor withheld to balance the 2015 budget.

This funding has also been included in the 2016 budget as well, but whether it will fall victim to withholding again is yet to be seen.

For now, the only options for many Missourians are to go to the emergency room when dental pain becomes unbearable, or to simply go without needed dental care. A report by the state said there are lots of non-traumatic dental complains at ERs in Missouri - 60,000 each year.

Back on the clinic floor, Henderson found out they were in need of more oral surgeons on the treatment floor. So she turned and headed toward the volunteer lunch area.

Carmon Armstrong, a Fulton resident, came to MOMOM to have a root canal procedure done and to get several fillings.

Credit Rebecca Smith / KBIA

Shouting over the loud chatter, she asked, "Do we have any dentists here that would be willing when they’re finished with lunch to do oral surgery?"

“We found four upstairs. One down here.”

After about 15 minutes, she found all of the dentists she needed. After that, it was time for lunch.

Saturday - Next Year, They'll Do It Again

Saturday went much the same as Friday. Hundreds of people queued outside for free dental services. By 2 p.m. in the afternoon a sign hung outside that explained the event had reached its capacity. There were still a few hundred people inside waiting for procedures, and it would take until 5 p.m. to complete them all.

Credit Bram Sable-Smith / KBIA

Ben Hopper and Gerry Murphy were already breaking down one of the rows of stations, folding up chairs and emptying the water from each station’s tools into a waste bucket. They were loading the equipment onto a trailer and preparing to send it to the next Mission of Mercy clinic, which was in Fairbanks, Alaska.

There will be eight more events after Fairbanks before the end of the year, in locations like Fresno, California and Washington, D.C. And then next year, they’ll do it all again.

These clinics exist, and will continue to exist, because the need itself exists throughout the country.

That’s why people were willing to wait in line for hours on a hot, humid summer day in Missouri to get their teeth pulled. Because really, most of them can’t get dental care otherwise.

By 4:30 p.m., the day had wound down. The majority of the waiting and screening areas had been packed up. Across the room, there were only a handful of dental chairs with their lights still shining into the mouths of the last few patients of the day.

Kenneth Fanning was the final patient of the 2-day clinic.

Credit Bram Sable-Smith / KBIA

By 4:45 p.m., there was only one. And within a few minutes the patient sat up and got out of the chair. The last patient, a man named Kenneth Fanning, walked across the room toward the exit where his fiancé was waiting. He smiled wide to show her his new grin.

“I’ve needed my teeth done for over five years. I’ve had to lance my infected gums with sewing needles myself, so yeah, to get things done so I don’t have to worry about that? Yeah.”

He made the drive Saturday morning from Dixon, Missouri, about an hour and a half away. He got in line at 5 a.m., went through and had two teeth pulled. Then, because the clinic only does one procedure at a time, he got back in line to have his front four teeth reconstructed. The whole process took 12 hours from the moment he got in line.

The Missouri House of Representatives has proposed adding $48 million in federal and state funds to next year’s Medicaid budget to cover adult dental care. Last week the Senate Appropriations Committee agreed to the additional $48 million, but with some caveats. The money would only be used to pay for preventative dental care, like maintenance and extraction procedures. Part of the $48 million would also go towards paying dentists more for these procedures. Currently, the state only reimburses dentists up to 35 percent of usual and customary costs.

A Missouri lawmaker is calling on Gov. Jay Nixon to preserve dental benefits for Medicaid recipients in next year's state budget when he signs the $26.4 billion spending plan into law later this month.